There is tubular atrophy, interstitial fibrosis and round cell
infiltration.- Vascular sclerosis:
Affecting small arterioles, venules in the renal medulla and the
submucosa of the renal pelvis and the urinary tract. - Transitional cell carcinoma (TCC) of urothelium:
TCC is commonest analgesic-associated tumour.
Clinical manifestations:
Female to male ratio is 7 : 1, in spite of ratio of analgesic
consumption is only 2 : 1 denoting female sex preponderance. The patient's
age is usually 40-60 years.
Analgesic nephropathy may be asymptomatic and is discovered
only on routine medical examination.
The patient may present with manifestations of progressive renal
impairment with more marked manifestations of tubular dysfunctions
including more severe metabolic acidosis than expected (if we consider
serum creatinine), early loss of concentrating ability with polyuria and
nocturia, sodium losing state, more osteodystrophy (renal bone disease)
and enzymuria.
Hypertension occurs in more than 60% of cases.
Gout occurs in 20% of cases. It is more common in males.